The Season of Hoverboards: A Case Series of Fractures.

OBJECTIVE: The aim of this study was to identify the types of pediatric orthopedic extremity fractures that are sustained as a result of hoverboard (self-balancing, self-propelling, 2-wheeled boards) use. METHODS: We performed a retrospective review of all orthopedic consultations from the emergency department at our institution from December 1 to 31, 2015. Data was collected on the injury mechanism, fracture location, management, and patient characteristics including sex, age, and hand dominance. RESULTS: A total of 307 patients with acute extremity injuries were evaluated for a 31-day period. Hoverboard use was identified as the mechanism of injury in 36 patients with 36 fractures (11.7%). The mean age of these 36 patients was 11 years (range, 4-17 y), with most being male (69.4%). There were 35 upper extremity fractures and 1 lower extremity fracture. Eight (22.9%) of the 36 hoverboard patients required closed reduction in the emergency department either under conscious sedation or hematoma block performed with local anesthetic. Four patients (11.1%) required operative treatment. CONCLUSIONS: The overall incidence of extremity fractures due to hoverboard riding seen in our emergency department during the holiday season was relatively high compared with other common childhood activities. The vast majority of these fractures involved the upper extremities. A moderate percentage of these injuries required closed reduction in the emergency department or surgical treatment. Additional studies examining the use of protective equipment while riding hoverboards, time from initial hoverboard use to injury, supervision, and the cost of treating these injuries should be conducted to further elucidate the nature of these injuries and work toward prevention.

A protocol for the management of pediatric type I open fractures.

BACKGROUND: The management of pediatric type I open fractures remains controversial. There has been no consistent protocol established in the literature for the non-operative management of these injuries. METHODS: A protocol was developed at our institution for the non-operative management of pediatric type I open forearm fractures. Each patient was given a dose of intravenous antibiotics at the time of the initial evaluation in the emergency department. The wound was then irrigated and a closed reduction performed in the emergency department. The patient was admitted for three doses of intravenous antibiotics (over approximately a 24-h period) and then discharged home without oral antibiotics. RESULTS: In total, 45 consecutive patients were managed with this protocol at our hospital between 2004 and 2008. The average age was 10 (range 4-17) years. The average number of doses of intravenous antibiotics was 4.06 per patient. Thirty patients (67 %) received cefazolin (Ancef®) as the treating medication and 15 patients received clindamycin (33 %). There were no infections in any of the 45 patients. CONCLUSION: In this study we outline a consistent management protocol for type I open pediatric forearm fractures that has not previously been documented in the literature. Our results corroborate the those reported in the literature that pediatric type I open fractures may be managed safely in a non-operative manner. There were no infections in our prospective series of 45 consecutive type I open pediatric forearm fractures using our protocol. Using a protocol of only four doses of intravenous antibiotics (one in the emergency department and three additional doses during a 24-h hospital admission) is a safe and efficient method for managing routine pediatric type I open fractures non-operatively.

Septic arthritis associated with closed intra-articular fracture: a case series.

BACKGROUND: Osteomyelitis in the setting of closed fractures is a recognized association in the literature, but to our knowledge, septic arthritis after a closed intra-articular fracture has not yet been reported. METHODS: We conducted a retrospective review of 3 cases of septic arthritis after closed intra-articular fractures of the proximal phalanx of the great toe, distal tibia, and distal humerus. RESULTS: The patients presented with fever, erythema, pain, and elevated infectious indices. All patients had a delay in diagnosis of up to 10 days. On diagnosis, all patients underwent open irrigation and debridement and were treated with organism-specific antibiotics for Staphylococcus aureus or Streptococcus pneumoniae. One patient required metatarsophalangeal joint arthrodesis, whereas the other 2 patients returned to full function after a prolonged treatment course. CONCLUSIONS: Septic arthritis after closed intra-articular fracture is a rare clinical condition and requires prompt diagnosis and treatment. LEVEL OF EVIDENCE: Level IV.

The healing forearm fracture: a matched comparison of forearm refractures.

BACKGROUND: Forearm fractures in children usually heal rapidly after closed treatment. Recent studies report forearm refracture rates of 5%. The purpose of this study was to identify risk factors for refracture based on radiographic variables. METHODS: We performed a retrospective review of patients that sustained a second forearm fracture (refracture) between 1998 and 2005. Refractures were defined as having a second fracture of the same forearm within 18 months of the original fracture. A comparison group of single-fracture patients followed in a capitated insurance plan were included and matched based on age and sex. Radiographic assessment included initial/final angulation, displacement, and fracture-line visibility at latest follow-up. RESULTS: Sixty-three refractures were compared with 132 age- and sex-matched single-fracture patients. Time to refracture averaged 10 months. Thirty-eight percent of the initial fractures in the refracture group occurred in the proximal or middle third of the forearm compared with 15% for the single-fracture patients (P < 0.001). Because location of the fracture was found to be a risk factor for refracture, a secondary analysis was performed with refracture patients matched to single-fracture patients based on age, sex, bone fractured, fracture location, and treatment method. Fracture-line visibility of the radius at latest follow-up was clearly visible in 48% of refractures compared with 21% of controls (P = 0.05). Initial fracture severity and residual deformity were not significantly different. CONCLUSIONS: Proximal and middle one third forearm fractures are at greater risk of refracture compared with distal one third forearm fractures. There was a trend toward incomplete healing seen more commonly in those that refractured, emphasizing the importance of longer immobilization in these fractures. LEVEL OF EVIDENCE: Prognostic study, level III, case-control study.